Dados do Trabalho

Título

Bickerstaff brainstem encephalitis a case report

RESUMO

Presentation:

Bickerstaff brainstem encephalitis (BBE) is a rare post-infectious neurological disease defined by the triad of ophthalmoplegia, ataxia and decreased consciousness. It is considered to be a variant of Miller Fisher syndrome.


Discussion:

We present the case of the patient T.A.O., 40 years old, female, admitted to the aforementioned nosocomium on 11-24-21 with flaccid quadriplegia and sensorium lowering. Aphasia. Currently, patient with no history of previous illness. But she had a history of using oral contraceptives and smoking. Initially, under suspicion of a cerebrovascular event, she was submitted to imaging tests and, due to acute respiratory failure, she was intubated and kept under intensive care.

After brain and cervical imaging exams did not show signs of vascular disease, blood tests were collected with serology for virus as well as cerebrospinal fluid collection, this one, without testing for viral serology. After a detailed interview with the family members it was reported, 15 days before the beginning of the events, episode of diarrhea with malaise lasting 24h.

This fact reinforced the hypothesis of post-infectious encephalitis. In this intercourse the patient was receiving anti-viral following treatment with human immunoglobulin for 5 days. Physical examination revealed. Facial diplegia, complete internal and external ophthalmoplegia. Flaccid tetraplegia. Chart, which according to medical literature, can be confused with brain death. In fact, electroencephalogram was performed that showed wakefulness activity, without pathological graphoelements. In fact, electroencephalogram was performed that showed wakefulness activity, without pathological graphoelements.

The results of viral serologies showed positivity for acute reaction to cytomegalovirus. Reinforcing the diagnosis. Slowly, after treatment with immunoglobulin, physiotherapeutic, nutritional and pressure wound prevention care, the patient recovered from diplegia. Improvement of ophthalmoplegia, flaccid tetraplegia. With slow improvement of ventilatory support. Six months after the beginning of the condition and treatment, the patient maintains tetraparesis with improvement of aphasia, without the need for ventilatory support, improvement of diplegia gradually recovering to basic activities such as feeding and verbal communication.

Final Comments:

Bickerstaff brainstem encephalitis may even be confused with brain death. This requires a lot of holistic care.

Palavras Chave

Bickerstaff brainstem encephalitis. Cytomegalovirus.